What questions should be asked to a patient 1 day post hiatal hernia repair during rounding?

Essential Questions for Post-Hiatal Hernia Repair Rounding on Day 1

The most important questions to ask a patient 1 day post hiatal hernia repair should focus on pain control, respiratory status, early signs of complications, and return of gastrointestinal function to optimize morbidity and mortality outcomes.

Pain Assessment

• What is your current pain level on a scale of 0-10?
• Where is your pain located? (Incisional, shoulder, chest, or abdominal)
• Is your pain adequately controlled with current medications?
• Have you experienced any new or worsening pain since surgery?

Respiratory Status

• Are you experiencing any difficulty breathing?
• Do you have any chest pain with breathing?
• Have you been able to use the incentive spirometer? How frequently?
• Are you experiencing any cough or shortness of breath?

Early Complication Detection

• Have you experienced any nausea or vomiting?
• Have you noticed any unusual drainage from your incision sites?
• Do you feel any new swelling or bulging around your surgical sites?
• Have you had any fever, chills, or sweats?

Gastrointestinal Function

• Have you been able to tolerate oral intake? Any difficulties swallowing?
• Have you experienced any reflux symptoms since surgery?
• Have you passed gas or had a bowel movement since surgery?
• Are you experiencing any hiccups or abdominal bloating?

Mobility Assessment

• Have you been able to get out of bed and walk?
• Are you experiencing any dizziness when standing or walking?
• Have you been able to perform daily activities (like using the bathroom) independently?

Patient Education Review

• Do you understand the dietary restrictions for the next few weeks?
• Do you understand the activity restrictions, particularly regarding lifting?
• Are you clear about which warning signs should prompt you to contact your doctor?

Special Considerations

• For patients with known risk factors for recurrence (height <160 cm, history of abdominoplasty, or tubal ligation): Have you been instructed on how to avoid activities that increase intra-abdominal pressure? 1
• For elderly patients: Have you been able to resume your normal mobility level?
• For patients with pre-existing GERD: Have you noticed any improvement in your reflux symptoms?

Discharge Planning

• Do you have any concerns about managing at home?
• Do you have someone to help you at home during your recovery?
• Do you understand your medication regimen, particularly for pain control?

Important Pitfalls to Avoid

1. Failing to assess for early signs of recurrence - Symptoms like sudden pain or difficulty swallowing may indicate early recurrence requiring prompt intervention
2. Overlooking respiratory complications - Pneumonia and atelectasis are common post-operative complications that can significantly impact morbidity
3. Missing signs of infection - Fever, increased pain, or unusual drainage may indicate surgical site infection
4. Neglecting patient education - Patients should understand that postoperative lifting or vomiting significantly increases recurrence risk (odds ratio = 11.6) 1
5. Inadequate pain control - Poor pain management can lead to respiratory complications due to shallow breathing and reduced mobility

Remember that patient education is essential, as patients are more receptive to information from physicians than nursing staff 2, and proper understanding of activity restrictions is crucial to prevent recurrence.